
Contents
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Introduction Introduction
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Physiological Effects and Pathophysiological Rationale of Using NIV in Critically Ill Patients Physiological Effects and Pathophysiological Rationale of Using NIV in Critically Ill Patients
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Principles of Ventilator Functioning Principles of Ventilator Functioning
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Pneumatic System Pneumatic System
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Control Variable and Phase Variables Control Variable and Phase Variables
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Control Variable Control Variable
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Triggering and Cycling Variables Triggering and Cycling Variables
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Limit Variable Limit Variable
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Baseline Variable Baseline Variable
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NIV Ventilators NIV Ventilators
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Respiratory Circuits Respiratory Circuits
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NIV Modes NIV Modes
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Non invasive CPAP Non invasive CPAP
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NIPPV NIPPV
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New Mode: Dual Modes New Mode: Dual Modes
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New Mode: Proportional-assisted Ventilation New Mode: Proportional-assisted Ventilation
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New Mode: Neurally Adjusted Ventilatory Assist New Mode: Neurally Adjusted Ventilatory Assist
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Monitoring Monitoring
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Interfaces in the Acute Setting Interfaces in the Acute Setting
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Types of Interfaces Types of Interfaces
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Intentional and Unintentional Leaks Intentional and Unintentional Leaks
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Dead Space and Mask Volume Dead Space and Mask Volume
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Non-vented Mask Non-vented Mask
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Vented Mask Vented Mask
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Humidification Humidification
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Patient Selection and Beginning of NIV Patient Selection and Beginning of NIV
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General Inclusion and Exclusion Criteria General Inclusion and Exclusion Criteria
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References References
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8 Non-invasive Ventilation in Critical Care
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Published:October 2023
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Abstract
Summary
Acute respiratory failure (ARF) is characterized by impaired gas exchange and increased work of breathing, secondary to an acute lung and/or respiratory pump failure. Ventilatory assistance to respiratory function can be applied either invasively through an endotracheal tube or by means of external interfaces, such as masks, mouthpieces, prongs, and helmets, referred to as non-invasive ventilation (NIV). Acute NIV needs to be provided in an appropriately skilled and equipped environment, with ready access to advanced respiratory therapies, including invasive mechanical ventilation. Effective use of NIV requires understanding of the ventilator system and interfaces. Key ventilator features include the nature of gas delivery (high-pressure or turbine-driven), the variables used for setting gas delivery, and the timing of breaths and the circuits. Ventilators can deliver either non-invasive continuous positive airway pressure (CPAP) or vary the positive pressure, at different levels (nPPV) to facilitate ventilation. A wide variety of interfaces are available, although those commonly used for acute NIV include orofacial masks, total face masks, and helmets. The type of ventilator, the settings on that ventilator, and the interface all need to be individualized to the patient dependent on their underlying pathology, physiological features, and capacity to tolerate NIV, and a careful approach to patient optimization is critical to successful use of NIV.
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